Provider Demographics
NPI:1013340371
Name:FULMER, PATRICIA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MARIE
Last Name:FULMER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14034 GREEN WAY PARK CIR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-5200
Mailing Address - Country:US
Mailing Address - Phone:256-653-8847
Mailing Address - Fax:
Practice Address - Street 1:11310 MEMORIAL PKWY SW STE G
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-2666
Practice Address - Country:US
Practice Address - Phone:256-808-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-D13-TA-951152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist